{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CLINTON   N STEVENS","gend":0,"add":"3824 LARCHWOOD DR","city":"VIRGINIA BEACH","state":"VA","zip":"23456-9998","dob":"1971-08-11","age":"","mstatus":"","insh":"1381597*01","cliId":"","pno":"757\/779-0108","cno":"757\/779-0108","email":"","ename":"","eno":"","pphy":"BHATTACHARYYA, BISWA MD","ppno":"757\/275-9331","pcpadd":"2088 S INDEPENDENCE BLVD STE #103","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23453,"pcpcounty":"","pcpid":172075,"pcpname":"Princess Anne Family Medicine","plan":"OHP","program":"ACA","lob":"Small Group","region":"TIDEWATER","aligned":"","ano":"757\/471-6149","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/416-7656","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E11.65","Z79.84","I10.","I25.10","E78.49","S93.402D","R60.0","M25.572","G47.33","R22.0","E11.9","M76.71","M20.21","M20.22","B35.1","H90.5","R42.","E11.59","R53.83","S93.402A"],"date":["2020-01-13","2020-06-19","2020-06-19","2020-01-13","2020-06-19","2020-12-18","2020-12-18","2020-12-18","2021-02-16","2020-06-23","2020-06-23","2020-02-03","2020-02-03","2020-02-03","2020-02-03","2021-03-08","2021-03-08","2020-06-19","2020-06-19","2020-09-14"],"priorHcc":["","","","","","","","","","","","","","","","","","","",""]}},{"a":[]}]},{"t":"Covid Screening","q":[{"a":[]}]},{"t":"Self-Assessment and Social History","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Activities of Daily Living","q":[{"a":[]}]},{"t":"Medical History","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Family History","q":[{"a":[]}]},{"t":"Preventive Care","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","13668010501","ISOSORB","60MG ER","90","Select","Select",""],["","57664047758","METOPROL","50MG","180","Select","Select",""],["","53885027150","ONETOUCH","VERIO","50","Select","Select",""],["","68382076010","METFORMIN","1000MG","180","Select","Select",""],["","45802014167","CICLOPIROX","8%","7","Select","Select",""],["","70377003012","ATORVASTATIN","80MG","90","Select","Select",""],["","68382005101","MELOXICAM","15MG","30","Select","Select",""],["","13668010501","ISOSORB ","60MG ER","90","Select","Select",""],["","57664047758","METOPROL ","50MG","180","Select","Select",""],["","45802014167","CICLOPIROX ","8%","7","Select","Select",""],["","53885027150","ONETOUCH ","VERIO","50","Select","Select",""],["","70377003012","ATORVASTATIN ","80MG","90","Select","Select",""],["","68382076010","METFORMIN ","1000MG","60","Select","Select",""],["","68382005101","MELOXICAM ","15MG","30","Select","Select",""],["","43598043611","NITROGLYCERN ","0.4MG","25","Select","Select",""],["","59676058015","JANSSEN","COVID-19","0","Select","Select",""],["","43598043611","NITROGLYCERN","0.4MG","25","Select","Select",""],["","59676058015","JANSSEN ","INJ COVID-19","0","Select","Select",""]]}},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Review of Systems and Diagnoses","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Pain","q":[{"a":[]}]},{"t":"Vital Signs","q":[{"a":[]},{"a":[]}]},{"t":"Exam Review","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Screenings Needed","q":[[["Yes","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""]]]},{"t":"Mini-Cog","q":[{"a":[]}]},{"t":"Home Safety & Personal Goals","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Active Problem Conditions","q":[{"a":[]}]},{"t":"Patient Summary","q":[{"a1":"","a2":"","a3":"","a4":"","a5":"","a6":"","a7":[],"a8":"","a9":"","a10":[],"a11":"","a12":""}]}]}